Arthroscopic Rotator Cuff Repair: Double-Row (Knotted Anchors Medial and Lateral)


Chapter 21

Arthroscopic Rotator Cuff Repair: Double-Row (Knotted Anchors Medial and Lateral)



Francesco Franceschi, Michele Paciotti, and Edoardo Franceschetti

Introduction


With advances in arthroscopic surgery, several techniques have been developed to increase the tendon–bone contact area, reconstituting a more anatomic configuration of the rotator cuff footprint and providing a better environment for tendon healing. On the basis of magnetic resonance imaging (MRI) findings, the double-row repair is a more anatomic construct, which better restores the native structures of the rotator cuff footprint. However, this does not seem to translate into superior clinical outcomes, except for large-to-massive tears (>3 cm), in which the double-row technique provides better clinical outcomes compared with the single row. For mobile crescent-shaped cuff tears, we propose the double-row fixation with anchors and knotted sutures as the standard for arthroscopic rotator cuff repair.

Procedure


The double-row repair is similar to that described by Lo and Burkhart. Two double-loaded 5.0-mm screws are inserted just lateral to the articular surface of the humeral head, with a center-to-center distance of approximately 1.5 cm in the anterior-to-posterior direction. The first medial anchor is inserted 5 mm from the bicipital groove. The suture strands from each medial anchor are passed approximately 7 mm apart in a mattress fashion. The lateral row consists of two double-loaded 5.0-mm screw suture anchors just lateral to the “drop-off” of the greater tuberosity, with a center-to-center distance of approximately 1.5 cm in the anterior-to-posterior direction. The suture from each lateral anchor is passed through the tendon as a simple stitch. All knots are completed with a static six-throw surgeon’s knot.

Patient History



Patient Examination





Imaging


Several imaging techniques are available to study the rotator cuff:


1. Radiographs



2. MRI



3. Echotomography



4. CT



Treatment Options: Nonoperative and Operative




Nonoperative



Operative



Surgical Anatomy


Shoulder Anatomy (Fig. 21.2)


Mar 28, 2020 | Posted by in ORTHOPEDIC | Comments Off on Arthroscopic Rotator Cuff Repair: Double-Row (Knotted Anchors Medial and Lateral)

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